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Therapeutic Lifestyle Coaching (TLC) for Nutrition: Clinical Pearls

SBHPP Speaker - Laurel Short
By: Laurel Short, DNP, FNP-C

Recently a colleague texted me and asked what my favorite resources are for weight management counseling. As I thought about what recommendations I make to patients who either voice a weight loss goal or are recommended to lose weight for medical conditions, I realized my approach to obesity and weight loss has shifted to a focus on open dialogue. As a nurse practitioner, I am passionate about healthy lifestyle behaviors and self-management. Through experience, I have learned it is more effective to have an open discussion about what has worked for the individual in the past and what approach they are interested in, rather than simply providing take-home resources.

It is widely accepted there is not a universal “diet” that we should all strive for when it comes to weight loss. Instead, we need to set specific, realistic goals to work toward. It can feel overwhelming to tackle both nutrition and exercise goals at once. While exercise is one of my favorite topics, we will focus on nutrition for the purpose of today’s blog. The following is the approach I take to shared-decision making with my patients and additional resources you can use to enhance your knowledge and approach to obesity management.

Nutrition Counseling Pearls

  1. It’s not a diet! We are coaching our patients for healthy nutrition that they will develop for long-term health.
  2. Providing a website or brochure is not typically productive, but taking even 5-10 minutes to write out goals and nutrition/food ideas IS!
  3. SMART goal setting: Specific, Measurable, Action-Oriented, Realistic, Time-Oriented
    Why don’t New Year’s Resolutions often stick? Because they are not specific enough. The same holds true for nutrition and weight loss. “I want to lose weight” is a vague, overwhelming goal. “I will eat a protein-focused breakfast within one hour of waking up and avoid eating for 2 hours before bedtime” is a specific, realistic goal.
  4. Rather than prescribing a diet plan, try writing out these types of recommendations:
    • Eat a vegetable serving at each meal (a vegetable blend juice at breakfast counts!)
    • Include a healthy fat at each meal- not only is this excellent for health, but it also curbs sweet cravings
    • Increase water intake (often thirst is mistaken for hunger)
    • Try to avoid screens while eating to improve cues of fullness and mindful eating
    • Avoid eating for 2 hours before bedtime
    • Aim for a protein-focused breakfast within 1 hour of waking (e.g., eggs, cottage cheese, turkey breakfast sausage, oatmeal with peanut butter mixed in)
    • Using a free app such as My Fitness Pal or a written food log to track intake has been shown to assist with weight loss and maintaining healthy habits
    • Recognition of the relationship between stress and eating/weight gain. Addressing stress and anxiety as part of weight loss is vital!
  5. Schedule more frequent follow-up visits to help patients check in with their goals and provide ongoing support. If meeting with a dietician is a financial option or covered by insurance, this is also a great option. However, patient resources (time, money) are limited- if they have a provider they are established with and trust, they will feel motivated and encouraged to work with them on nutrition/weight loss.

Weight management and nutrition are some of the most common issues in the primary care setting. By utilizing SMART goal setting and simple nutrition changes, we can motivate our patients to reframe “dieting for weight loss” to “nourishment for life.”

Additional resources to further your knowledge of obesity management:

CEU courses, treatment tools/algorithms, and patient education tools at: https://www.aanp.org/practice/clinical-resources-for-nps/clinical-resources-by-therapeutic-area/obesity-and-weight-management

• “Just Some Podcast” January 2020 episode
• NP Pulse- multiple episodes

See Laurel Short, DNP, FNP-C speak at a 2021 Skin, Bones, Hearts & Private Parts conference in Virginia Beach • Pensacola • San Antonio • Atlanta